Pedicled,vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis

Atlantoaxial pseudoarthrosis is a challenging postoperative complication. The use of a local, vascularized bone graft, without free tissue transfer, to support a revision atlantoaxial fusion has not been previously described. We report the first surgical patient who received a semispinalis capitis muscle pedicled, occipital bone graft for supplementation of a revision atlantoaxial arthrodesis. A 72-year-old female had a failed atlantoaxial fusion and developed neck pain from continued instability and fractured hardware. The fixation and fusion were revised and supplemented with a novel, pedicled occipital bone graft. A craniectomy was performed in the occipital bone while still attached to the semispinalis capitis muscle to provide graft vascularity. This graft was rotated inferiorly from the skull base to the C1 arch and C2 spinous process in order to supplement a revision atlantoaxial arthrodesis. The patient had excellent clinical recovery over 18-month clinical follow up. The bone graft harvesting and rotation were performed safely and without complication. The 6-month postoperative CT scan showed partial fusion into the graft. This novel surgical technique leverages the advantages of vascularized structural autograft without adding extensive time or morbidity to the procedure as observed in free-tissue transfers. It is a safe and useful salvage technique to supplement revision atlantoaxial fusion surgeries.     

Impact of surgical site infection and surgical debridement on lumbar arthrodesis: A single-institution analysis of incidence and risk factors

This study identifies the rate of pseudarthrosis following surgical debridement for deep lumbar spine surgical site infection and identify associated risk factors. Patients who underwent index lumbar fusion surgery from 2013 to 2014 were included if they met the following criteria: 1) age >18 years, 2) had debridement of deep lumbar SSI, and had 3) lumbar spine AP, lateral and flexion/extension X-rays and computed tomography (CT) at 12 months or greater postoperatively. Criteria for fusion included 1) solid posterolateral, facet, or disk space bridging bone, 2) no translational or angular motion on flexion/extension X-rays, and 3) intact posterior hardware without evidence of screw lucency or breakage. Twenty-five patients (age 63.2 ± 12.6 years, 10 male) involving 58 spinal levels met inclusion criteria. They underwent fusion at a mean of 2.32 [range 1–4] spinal levels. Sixteen (64.0%) patients received interbody grafts at a total of 34 (58.6%) spinal levels. All underwent surgical debridement with removal of all non-incorporated posterior bone graft and devascularized tissue. At one-year postoperatively, (56%) patients and 30 (52%) spinal levels demonstrated radiographic evidence of successful fusion. Interbody cage during initial fusion was significantly associated with successful arthrodesis at follow-up (p = 0.017). There is a high rate of pseudoarthrosis in 44% of patients (48% of levels) undergoing lumbar fusion surgery complicated by SSI requiring debridement. Use of interbody cage during initial fusion was significantly associated with higher rate of arthrodesis.     

Expandable intramedullary nailing and platelet rich plasma to treat long bone non-unions

Background  Roentgenographic and functional outcomes of expandable self locking intramedullary nailing and platelet rich plasma (PRP) gel in the treatment of long bone non-unions are reported. Materials and methods  Twenty-two patients suffering from atrophic diaphyseal long bone non-unions were enrolled in the study. Patients were treated with removal of pre-existing hardware, decortication of non-union fragments, and fixation of pseudoarthrosis with expandable intramedullary nailing (Fixion™, Disc’O Tech, Tel Aviv, Israel). At surgery, PRP was placed in the pseudoarthrosis rim. Results  The thirteen-month follow-up showed 91% (20/22 patients) of patients attaining bony union. The average time to union was 21.5 weeks. No infection, neurovascular complication, rotational malalignment, or limb shortening >4 mm were observed. The healing rate of non-unions was comparable to that observed in previous studies but with a lower complication frequency. Conclusions  The combined use of self locking intramedullary nailing and PRP in the management of atrophic diaphyseal long bone non-unions seems to produce comparable results with less complications than previously reported. Further data are warranted to investigate the single contribution of PRP gel and Fixion nail.     

Lumbar spine anomalies in a pycnodysostosis case

Summary We report a case of pycnodysostosis in which several clefts in the laminas, interarticular parts, and pedicles of the whole lumbar spine were revealed for the first time on CT. We review similar findings in the literature, and discuss their pathogenesis.     

Ankylosing spondylitis complicated by pseudoarthrosis and secondary spinal stenosis

When a patient with longstanding ankylosis spondylitis presents with acute back pain, one should always consider the possibility of a pseudoarthrosis. Magnetic resonance imaging is important in the evaluation of this complication because of the association of spinal stenosis.     

Spontaneous union of bilateral congenital pseudoarthrosis of the clavicle,in a baby

Congenital bilateral pseudoarthrosis is an extremely rare condition. We report a neonate with bilateral congenital clavicle pseudoarthrosis. The neonate had a palpable gap bilaterally. Radiological examination confirmed the diagnosis. The baby had a complete spontaneous healing in a year. We review the recent literature.     

Platelet-Rich Plasma,Mesenchymal Stem Cell,and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

BackgroudWe performed a systematic review on the management of patellar fracture nonunion and report a novel suture-based non-metallic fixation technique associated with platelet-rich plasma and mesenchymal stem cell injections in the management of this injury.MethodsA systematic search was performed up to August 2020 in PubMed and Scopus electronic databases of scholarly articles evaluating different surgical techniques used for nonunion of patellar fractures, with no restrictions on language or year of publication. Furthermore, we describe our novel non-metallic suture fixation technique and a patient in whom this technique was applied.ResultsA total of 9 articles were included in the systematic review. Tension band wiring was the most commonly used procedure (62.7%). Nonoperative procedures (8.1%) resulted in nonunion in all patients. The most common complication after open reduction and internal fixation was infection (7.8%). Our patient at the latest follow-up reported full functional recovery and full extension and flexion of the affected knee with no pain and subjectively normal strength.ConclusionsThe management of patella nonunions is still a challenge. The technique reported here can be used in patellar fracture nonunion, as well as in primary patellar fractures.     

先天性胫骨假关节（CPT）的超微结构

目的：深入了解先天性胫骨假关节（CPT）的病理变化、细菌类型及其病变来源。方法：取5例先天性胫骨假关节（CPT）标本中不同部位的组织20例,经固定、切片染色后置于透射电镜下进行观察。结果：（1）断端间组织及病变骨膜组织性质完全一样,均为致密纤维结缔组织,细胞成分多,主要为纤维母细胞、肌纤维母细胞及少量未分化细胞。（2）移行部位骨膜组织结构和病变处骨膜组织结构相似。（3）断端处骨质细胞稀少,部分骨细胞萎缩或坏死,部分骨细胞含有空泡,骨基质未见异常。（4）移行部位骨质未见明显异常表现。结论：（1）先天性胫骨假关节（CPT）是非神经起源的、而是起源于骨膜的一种细胞增生活跃的纤维增生性变;（2）肌纤维母细胞与CPT发病有关。     

腰椎椎间融合器应用中的并发症分析

目的: 对使用腰椎融合器中的并发症进行统计及分析。方法: 回顾性随访及统计共 80例使用腰椎融合器的腰椎退行性变患者出现的术中、术后并发症, 并进行分析。结果:术中出现的硬脊膜撕裂 2例 (2. 5% ), 未出现椎间融合器位置不佳。发生神经根牵拉症状患者3例 (4% ), 发生椎间融合器塌陷患者 2例 (2. 6% ), 无患者发生椎间隙感染。其中同时出现两种及两种以上并发症的患者 3例 (4% )。结论: cage在腰椎融合术存在发生手术并发症的可能性, 术中注意避免过度牵拉及联合应用C臂机可减少并发症的发生。